SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

SB 617 (Glazer) - Pharmacy technicians: supervision

Bill Summary:

Senate Bill 617 would require an employer to utilize a ratio of three pharmacy technicians (PTs) to one pharmacist (3:1) if the employer and one or more labor organizations representing the employed pharmacists, PTs, or a combination of the two have entered into a collective bargaining agreement (CBA) agreeing to the ratio. Would require the Board of Pharmacy (Board) to approve an application to use the 3:1 ratio if the employer establishes a manual, as specified.

Fiscal Impact:

• $218,000 in 2020-21 and $210,000, ongoing, to fund 1.0 Pharmacy Inspector at the Board of Pharmacy to inspect facilities utilizing the provisions in this bill.  
• $5,500 in IT costs to create new enforcement codes and flag licensee records that are approved to operate with an increased ratio of pharmacy technicians per pharmacist. Although the Department of Consumer Affairs indicates that workload will be funded through the redirection of existing maintenance resources, staff notes the potential cumulative impact of proposed legislative proposals would directly impact existing workload.

Background:

The Board of Pharmacy oversees licensure and regulation of approximately 47,114 active pharmacists and 70,877 active pharmacy technicians (PT). Pharmacists advise patients, physicians, and other health practitioners on the selection, dosages, interactions, and side effects of medications. AB 1244, Chapter 841, Statutes of 1991, authorizes the licensure of PT. According to the committee policy analysis of this bill, the rationale for AB 1244 was that having a PT perform non-discretionary duties, as defined, would enable the pharmacist to provide more services to a larger number of patients. Title 16, Division 17, Article 11, Section 1793.2 defines “nondiscretionary tasks” as: removing the drug or drugs from stock; counting, pouring or mixing pharmaceuticals; placing the product into a container; affixing the label or labels to a container; and packaging and repackaging.

Current law requires all practice settings, except for an inpatient of a health facility, a patient of a home health agency, an inmate of a correctional facility, or for a person receiving treatment through specified state services, the pharmacist to PT ratio as one to one (1:1) (BPC § 4115 (f)(1)). Any additional pharmacists shall oversee no more than two PTs, except if those PTs are performing specified clerical functions.

Proposed Law:

• The bill includes the following provisions, among others:
• Authorizes an employer and one or more labor organizations representing employees who are pharmacists, pharmacy technicians, or a combination thereof, to enter into a collective bargaining agreement providing a ratio of up to 3 to 1 pharmacy technicians per pharmacist, regardless of whether the pharmacy has only one pharmacist or more than one pharmacist.
• Provides that the 3:1 ratio does not apply for an inpatient of a licensed health facility, a patient of a licensed home health agency, an inmate of a correctional facility of the Department of Corrections and Rehabilitation, for a person receiving treatment in a facility operated by the State Department of State Hospitals, the State Department of Developmental Services, or the Department of Veterans Affairs, and to personnel performing clinical functions.
• Requires the Board to approve an application from an employer to use the 3:1 ratio if all of the following conditions are met:
  • The employer applies to the board.
  • The employer demonstrates that, prior to using the 3:1 ratio, the employer will fulfill all specified activities, including, but not limited to, establishing that the pharmacist technician is licensed and receives in-service training.
  • The pharmacist-in-charge must review the policies and procedures manual at least every two years and, if necessary, amend the manual as needed. Documentation of the review of the manual must be made available to the board upon request.

Related Legislation:

1. SB 1286 (Pan, 2018) would have expanded the ratio of one pharmacist to four PTs. This measure was withdrawn at the request of the author in the Senate Committee on Business, Professions, and Economic Development.

The Board of Pharmacy discussed the bill at its May 8, 2019, board meeting, and on a voted to refer the measure for further consideration to its legislative subcommittee.

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SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Steven Glazer, Chair

2019 - 2020 Regular

Bill No: SB 617 Hearing Date: April 22, 2019

Subject: Pharmacy technicians: supervision

SUMMARY:

Allows an employer to utilize a ratio of three pharmacy technicians (PTs) to one pharmacist if the employer and one or more labor organizations representing the employed pharmacists, PTs, or a combination of the two have entered into a collective bargaining agreement (CBA) agreeing to that ratio. Requires the California State Board of Pharmacy (Board) to approve an application to use the three to one ratio if the employer establishes a manual delineating the responsibilities and duties of PTs, as specified.

Existing law:

1. Establishes the Board in the Department of Consumer Affairs to administer and enforce the Pharmacy Law, which licenses and regulates pharmacists PTs, among other licensees. (Business and Professions Code (BPC) § 4001 (a))
2. Defines a PT as an individual who assists a pharmacist in a pharmacy in the performance of his or her related duties, which shall include packaging, manipulative, repetitive, or other nondiscretionary tasks only while assisting, and while under the direct supervision and control of, a pharmacist. Clarifies that a PT can only perform the above tasks with a pharmacist on duty. Prohibits a PT from performing any act requiring the exercise of professional judgment by a pharmacist. (BPC §§ 4038, 4115 (a-c))
3. Requires the Board to adopt regulations to specify tasks that a PT may perform under the supervision of a pharmacist. Provides that any pharmacy that employs a PT shall do so in conformity with the regulations adopted by the Board.
   (BPC § 4115 (d))
4. Provides that no person shall act as a PT without first being licensed by the Board. (BPC § 4115 (e))
5. Establishes that a pharmacy with only one pharmacist shall have no more than one PT (1:1). Establishes that any additional pharmacists shall oversee no more than two PTs, except if those PTs are performing specified clerical functions. Establishes that this ratio applies to all practice settings except for an inpatient of a health facility, a patient of a home health agency, an inmate of a correctional facility, or for a person receiving treatment through specified state services. (BPC § 4115 (f)(1))
6. Authorizes the Board to adopt regulations establishing the ratio of PTs to pharmacists for an inpatient of a health facility or a patient of a home health agency. (BPC § 4115 (f)(2))
7. Authorizes a pharmacist scheduled to supervise a second PT to refuse the duty if he or she determines that the additional PT would interfere with the responsibilities of the pharmacist. (BPC § 4115(f)(3))
8. Requires the Board to establish regulations to permit the temporary absence of a pharmacist for breaks and lunch periods without closing the pharmacy.
   (BPC § 4115 (g))
9. Establishes that the pharmacist on duty is directly responsible for the conduct of a PT that he or she supervises. (BPC § 4115 (h))

This bill:

1. Authorizes an employer and one or more labor organizations representing pharmacists, PTs, or a combination thereof to enter into a CBA that provides a ratio of up to three to one (3:1) PTs per pharmacist.
2. Prohibits this 3:1 ratio from applying to an inpatient of a licensed health facility; a patient of a home health agency; an inmate of a correctional facility; a person receiving treatment in a facility operated by the State Department of State Hospitals, the State Department of Developmental Services, or the Department of Veterans Affairs; or to personnel performing specified clinical functions.
3. Requires the Board to approve an application from an employer to use the 3:1 ratio if certain conditions are met, including but not limited to demonstrating a PT has knowledge and training to perform their duties and maintaining a policies and procedures manual that outlines specific duties and includes specified information.
4. Makes various technical, non-substantive changes.
   

FISCAL EFFECT:

Unknown. This bill is keyed fiscal by Legislative Counsel.

COMMENTS:

1. Purpose. This bill is sponsored by the Author. According to the Author, SB 617 would increase California’s PT ratio to 3: 1 to allow licensed pharmacists to focus on the aspects of their job that require high levels of training and experience, including consulting with patients, while allowing licensed PTs to perform other tasks to keep the pharmacy running smoothly.

The Author notes that “Nearly 20 years ago, a task force of the National Association of Boards of Pharmacy recommended the elimination of pharmacist-technician ratios. A survey of pharmacists at the time determined that more than two-thirds of their time was spent on non-clinical, non-judgmental tasks that could be handled by pharmacy technicians or other personnel. Most states followed this recommendation and have either no limits on pharmacy technicians or much higher limits than California. There is no evidence that these higher ratios have in any way endangered the health and safety of patients.”

According to the Author, “California remains stuck in the era when the use of pharmacy technicians was strictly limited. Today a California pharmacist in a retail setting may supervise only one pharmacy technician. Each additional pharmacist in a single location may supervise up to two technicians. There is no scientific basis for this limit, which results in higher costs and forces pharmacists to perform duties that distract them from their primary purpose.”

The Author notes that SB 617 includes a series of requirements to ensure that PTs are properly trained and supervised and that they perform only those duties for which they are licensed. As an extra measure of safety, the higher ratios would be allowed only in retail pharmacies under a collective bargaining agreement representing either pharmacists, PTs or both.

According to the Author, “this measure will provide relief for pharmacists, create good jobs for individuals with only a high school diploma and technical training, and provide better service to patients. It is long overdue.”

1. Background.
2. Pharmacists and the Expansion of Pharmacists’ Practice. At present, there are 47,114 active pharmacists and 70,877 active PTs licensed by the Board. Pharmacists are legally and ethically bound to advise their patients, physicians, and other health practitioners on the selection, dosages, interactions, and side effects of medications as well as monitor the health and progress of those patients to ensure that they are using their medications safely and effectively. According to BPC § 4001.1, the highest priority for the regulation of pharmacists is protection of the public.
   
   In 2013, the Governor signed SB 493 (Hernandez, Chapter 469, Statutes of 2013), which significantly expanded the scope of practice of pharmacists. Pharmacists are now, without a prescription from a physician, permitted to:

• Vaccinate their patients.
• Aid their patients in the administration of self-administered hormonal contraception.
• Provide nicotine replacement products.
• Furnish travel medications recommended by the CDC for individuals traveling outside of the United States.
• Perform emergency contraception drug therapy.
• Perform skin punctures.
• Substitute a drug product with the same active ingredients of equivalent strength.
• Dispense a Schedule II controlled substance as a partial fill.

The Board has, by regulation, promulgated extensive protocols governing each of these duties.

SB 493 also established “advanced practice pharmacist” recognition, allowing such pharmacists to:

• Order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies.
• Perform patient assessments; order and interpret drug therapy-related tests.
• Refer patients to other providers.
• Initiate, adjust and discontinue drug therapy in specific circumstances, providing notification to the diagnosing prescriber.
• Participate in the evaluation and management of diseases and health conditions in collaboration with other providers.

Pharmacists provide patient care with a goal of optimizing medication therapy and promoting health, wellness, and disease prevention. Pharmacists complete a four year post-graduate doctoral training program that includes extensive training in human anatomy and physiology, recognition and treatment of diseases and conditions, pharmacology, optimal medication use, as well as experience in direct patient care in multiple health care settings through clinical rotations.

Many pharmacists complete a residency program and obtain board certification in a specialized area of practice. Throughout the U.S., since 2003, all schools of pharmacy now only offer a doctorate in pharmacy (Pharm D) which includes course study on: Basic Life Support, Diagnosing & Disease State Management of Diabetes, Infectious Diseases, Hypertension, Heart Disease, Oncology; Immunization Training, Medication Management, Pharmacy Law/Administration, Pharmacy Practice, Therapeutic Drug Monitoring, Therapeutics. The Pharm D, which has been the sole degree awarded in California since the 1970s, includes over 1000 hours in pharmacology as well as clinical rotations, specifically one to two ambulatory rotations, one to three inpatient rotations, one or more retail rotations and one or more elective rotations in either geriatrics, long-term care or medication therapy management. Pharmacists may also choose to complete certificate programs focused on the management of specific disease or other certification to demonstrate competency and expertise in a certain area. In addition to meeting educational and experience requirements, an applicant for licensure as a pharmacist must take and pass both the North American Pharmacist Licensure Examination and the California Practice Standards and Jurisprudence Examination for Pharmacists.

1. Pharmacy Technicians. The law creating registration for PTs was enacted in 1991 (AB 1244, Polanco, Chapter 841, Statutes of 1991), in part to free up pharmacists to perform additional duties that they had been trained for and were being required to perform (e.g., patient counseling). The rationale for AB 1244 was that having a PT perform non-discretionary duties that do not require a pharmacist's professional training or judgment would enable the pharmacist to provide more services to a larger number of patients. The Board’s regulations (Title 16, Division 17, Article 11, Section 1793.2) define “nondiscretionary tasks” as:

• Removing the drug or drugs from stock
• Counting, pouring or mixing pharmaceuticals
• Placing the product into a container
• Affixing the label or labels to a container
• Packaging and repackaging.

PT applications are required to include a description of the applicant’s qualifications, along with supporting documentation for those qualifications and applicants are required to undergo a criminal background and fingerprint check. PTs must wear identification clearly identifying themselves as a PT in a pharmacy and may only perform duties under the direct supervision of a pharmacist, ensuring that a pharmacist is fully aware of all activities involved in the preparation and dispensing of medications, including the maintenance of appropriate records.

• 1. Health Care Workforce. On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into federal statute. The ACA, which states will began implementing in 2014, represents one of the most significant expansions and overhauls of the United States health care system since the passage of Medicare and Medicaid in 1965. The ACA aimed to increase the rate of health insurance coverage for Americans and to reduce the overall costs of health care. It provided a number of mechanisms including mandates, subsidies and tax credits to employers and individuals in order to increase the rate of people with coverage. California opted to fully implement the ACA and expanded Medi-Cal and created the state-based insurance marketplace, Covered California. According to the Public Policy Institute of California (PPIC), as of October 2017, about 3.8 million Medi-Cal enrollees gained coverage through this expansion. Total enrollment in Covered California has been between 1.2 and 1.4 million. In total, PPIC reports that the share of Californians with no health insurance dropped nearly 10 percentage points.

Before the passage of the ACA, it was anticipated that the newly insured will increase demand for health care on an already strained system. According to a 2017 report by the Robert Wood Johnson Foundation, interviews with healthcare stakeholders in communities with large increases in the number of insured people show that healthcare providers (including pharmacies) have expanded staff, opened new sites, and expanded hours in response to the increased demand for services.

• 1. Pharmacists to Pharmacy Technician Ratio. The pharmacist to PT ratio varies by state, from 1:1 in California up to 1:6 in Idaho. The majority of states have a 1:4 ratio for retail community pharmacies. Some states vary the ratio depending on the setting or the certification status of the PTs, and some do not even set a ratio. California limits the ratios of pharmacists to PTs at 1:1, but allows the ratio to increase to 1:2 for additional pharmacists, thus resulting in an effective ratio or 2:3 or 3:5 and so on. PTs are not included in the limited ratio if they are performing only specified clerical functions. Additionally, settings providing for an inpatient of a health facility, a patient of a home health agency, an inmate of a correctional facility, or a person receiving treatment through specified state services are exempt from the limiting ratio. As far back as 2004, the National Association of Boards of Pharmacy has recommended eliminating the ratio of pharmacists to PTs entirely.

This bill would not apply to the settings already exempt from the current statutory ratio. Currently, the landscape of California pharmacies is varied in how and whether its pharmacists and PTs are represented by unions. Prior attempts by the California Legislature to expand the ratio have been met with opposition by various parties claiming that a pharmacist would be unable to properly and safely supervise more than one technician and that a pharmacist would be increasing their liability by overextending their supervisorial powers.

1. Related Legislation This Year. AB 690 (Aguiar-Curry) establishes qualifications for a PT working at a remote dispensing site pharmacy. (Status: This measure is currently pending on the Assembly Floor.)

SB 655 (Roth) would increase the hours required for a PT externship program, would authorize a reverse distributor to acquire a dangerous drug or device from a previously licensed source, would update renewal requirements for an advanced pharmacist recognition, would require licensing fees for government entities, and would make technical changes, as specified. (Status: This measure is currently pending in the Senate Committee on Appropriations.)

1. Prior Related Legislation. SB 1286 (Pan, 2018) would have allowed a pharmacy with only one pharmacist to have up to four PTs. (Status: This measure was withdrawn at the request of the Author in the Senate Committee on Business, Professions, and Economic Development.)

SB 1442 (Wiener, Chapter 569, Statutes of 2018) prohibits a community pharmacy from requiring a pharmacist employee to engage in the practice of pharmacy at any time the pharmacy is open to the public, unless another employee is made available to assist the pharmacist at all times.

AB 1589 (Bocanegra, 2017) directed the Board to biennially review the ratio of PTs to pharmacists and report to the Legislature any recommended changes to the ratio. (Status: This measure died in the Assembly Committee on Appropriations.)

AB 401 (Aguiar-Curry, Chapter 548, Statutes of 2017) authorizes a remote dispensing site pharmacy to use a telepharmacy system, and would require the Board to issue a remote dispensing site pharmacy license; requires a remote dispensing site pharmacy to be located in a medically underserved area; authorizes a pharmacist to serve as a supervising pharmacist to provide telepharmacy services for up to two remote dispensing site pharmacies; authorizes a licensed remote dispensing site pharmacy to order dangerous drugs and devices and controlled substances and authorizes a PT to receive and sign for the delivered order; authorizes a PT to work at a remote dispensing site pharmacy and to perform tasks under the supervision of a pharmacist using a telepharmacy system; and, authorizes a pharmacist at a supervising pharmacy to supervise up to two PTs at each remote dispensing site pharmacy in addition to any PTs supervised at the supervising pharmacy.

SB 1039 (Hernandez, Chapter 319, Statutes of 2014) made changes to the authorized tasks of a PT under the direct supervision or control of a pharmacist; and authorizes intern pharmacists to perform specified tasks.

SB 493 (Hernández, Chapter 469, Statutes of 2013) allowed pharmacists to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that are recommended for international travelers; order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies; order and administer routine vaccinations; and provide consultation on drug therapy, disease management, and prevention.

AB 2743 (Matthews, 2006) would have prohibited a pharmacy from employing more than eight ancillary personnel, which include interns pharmacists, PTs, and PT trainees, per pharmacist. It would have given a pharmacist discretion as to how many personnel he or she supervises. (Status: This measure was withdrawn at the request of the author before its scheduled hearing in the Assembly Committee on Business and Professions.)

AB 536 (Bates, Chapter 352, Statutes of 2001) increased the 1:1 ratio of PTs to pharmacists to two PTs for each additional pharmacist in those pharmacies with more than one pharmacist. Permitted a pharmacist to refuse to supervise a second PT if the pharmacist determined that a second PT would interfere with the effective performance of the pharmacist's responsibilities.

AB 1244 (Polanco, Chapter 841, Statutes of 1991) provides for the registration of PTs by the Board.

1. Arguments in Support. CVS Health states that pharmacists spend 44% of their workday, on average, performing PT-level tasks. They argue that “[as] pharmacists are allowed to employ properly educated and trained technicians, pharmacists spend less time performing technician duties and more time completing pharmacists only duties.” Additionally, they point out that “[an] expansion of pharmacy technician ratios would not be unique to California. Over the past several years states have expanded their ratios. The majority of states in the nation allow pharmacists to supervise four or more technicians. No states has moved in the opposite direction to be more restrictive.”

The United Food & Commercial Workers Union states that “[the] existence of [a collective bargaining] agreement offers safety for whistleblowing pharmacists or pharmacy techs working for large corporations to complain about the ratio increase impairing their ability to perform their licensee functions. No comparable protections for pharmacists or pharm techs exist in non-unionized businesses. This protection is essential. Without this protection, pharmacists whose capacity to work as a licensed pharmacist may be impaired by the increase in the number of pharmacy technicians the pharmacist must supervise will be far more reluctant to complain for fear of retaliation, posing a risk to patients and public health.”

1. Arguments in Opposition. The United Nurses Associations of California/ Union of Health Care Professions opposes this bill “because it would be a danger to patients, the community, and would negatively impact already overburdened pharmacists with additional supervisorial duties.” They assert that the current ratio “provides a reasonable and workable balance of supervisorial duties for pharmacists to help ensure pharmacy technicians are performing their duties correctly. It also allows pharmacists to reduce medication errors and other mistakes by pharmacy technicians, while still performing their patient consultations and patient care responsibilities” and that this bill’s “dramatic tripling of the current supervisorial duties will require pharmacists to spend more time monitoring pharmacy technicians, to the detriment of their ability to ensure patient safety.”
2. Policy Concerns and Suggested Amendments
   1. Severability Clause. It is unclear whether the severability clause included in this measure is necessary. To the committee staff’s knowledge, there are no relevant federal laws that would preempt such a measure. As such, the Author may wish to strike this provision, specifically:

On page 7, delete lines 1-15.

• 1. CBA Clarity. SB 617 provides that an employer can only use an increased ratio if “an employer and one or more labor organizations representing employees who are pharmacists, PTs, or a combination thereof in an employer’s pharmacy may enter into a bona fide collective bargaining agreement providing a ratio of up to 3 to 1 PTs per pharmacist.” However, in instances where the PTs and pharmacists are separately represented, it is unclear if the employer must enter into a CBA with both parties. The Author may wish to consider amendments to clarify this issue. Additionally, there is no provision describing what would happen if the CBA expired. The Author should consider working with stakeholders to resolve this issue.
  2. Independent Community Pharmacies. The pharmacy industry has a variety of business models. While some larger retailers are poised to enter into CBAs, smaller and/or independently run pharmacies may not be well suited for a similar arrangement. However, given the expansion in scope of practice in what a pharmacist can do, independent pharmacies could also benefit from an expanded ratio. The Author should consider working with stakeholders to resolve this issue.

SUPPORT AND OPPOSITION:

Support:

CVS Health

United Food & Commercial Workers Union

Opposition:

Rite Aid

United Nurses Associations of California/ Union of Health Care Professions

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SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Steven Glazer, Chair

2019 - 2020 Regular

Bill No: SB 617 Hearing Date: April 1, 2019

Subject: Audiologists and hearing aid dispensers: sales of hearing aids

SUMMARY:

Requires a hearing aid dispenser and audiologist to provide a consumer with an electronic receipt, if requested.

Existing law:

1. Establishes the Speech Language Pathology, Audiology and Hearing Aid Dispensers Board (SLPAHADB) within the Department of Consumer Affairs (DCA) until January 1, 2022 with licensing and regulatory authority for speech-language pathologists, speech language pathology assistants, speech-language pathology aides, audiologists, dispensing audiologists and hearing aid dispensers. (Business and Professions Code (BPC) §§ 2530 et seq.)
2. Requires a licensed hearing aid dispenser to provide a consumer who purchases a hearing aid a written receipt that contains the date of sale; the make, serial number, and model number of the hearing aid; the hearing aid dispenser’s address and office hours where he or she is available to provide fitting, post-fitting adjustments, and servicing of the hearing aid; a statement about whether the hearing aid is used or reconditioned; terms of guarantee or written warranty; and the licensee’s license number. (BPC § 2538.35)
3. Requires a licensed audiologist to provide a written receipt containing the same information in 1) above to a purchaser of a hearing aid. (BPC § 2539.4)
4. Establishes, pursuant to the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), certain requirements relating to the provision of health insurance, including provisions relating to the confidentiality of health records. HIPAA prohibits a covered entity that uses electronic means to perform HIPAA-covered transactions from using or disclosing personal health information except pursuant to a written authorization signed by the patient or for treatment, payment, or health care operations. Notwithstanding those provisions, HIPAA allows a covered entity to maintain a directory of patients in its facility for specified purposes, and to disclose the protected health information of a patient to family members, relatives, or other persons identified by the patient, if certain conditions are met. Covered entities include health plans, health care clearinghouses, such as billing services and community health information systems, and health care providers that transmit health care data in a way that is regulated by HIPAA. HIPAA further provides that if its provisions conflict with a provision of state law, the provision that is most protective of patient privacy prevails. (Public Law 104–191, 104th Congress)
5. Prohibits, pursuant to the state Confidentiality of Medical Information Act (CMIA), a provider of health care, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. A violation of the provisions of this act that results in economic loss or personal injury to a patient is a crime. (Civil Code (CC) §§ 56, et seq.)
6. Defines, for purposes of the CMIA, “medical information” to mean “any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental or physical condition, or treatment.” “Individually identifiable” means that the medical information includes or contains any element of personal identifying information sufficient to allow identification of the individual, such as the patient’s name, address, electronic mail address, telephone number, or social security number, or other information that, alone or in combination with other publicly available information, reveals the individual’s identity.” (CC § 56.05(g))

This bill requires a hearing aid dispenser and audiologist to provide a consumer who purchases a hearing aid with an electronic receipt, if requested.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by Legislative Counsel.

COMMENTS:

1. Purpose. The Author is the Sponsor of this measure. According to the Author, paper receipts received by consumers for services can easily be misplaced and, considering the importance of information contained within a receipt for a hearing aid, offering the ability to receive a transaction record electronically is a simple step to better allow for the management of hearing health.
2. Background. The National Institute on Deafness and Other Communication within the National Institutes of Health advises that approximately 15 percent of American adults (37.5 million) aged 18 and over report some trouble hearing and about 28.8 million adults could benefit from using hearing aids.

According to information provided to consumers by the SLPAHADB, hearing aid dispensers are individuals licensed to fit and sell hearing aids while audiologists are professionals with a graduate degree, typically a doctorate degree, licensed to provide diagnostic hearing evaluations who can also be licensed to dispense hearing aids. Hearing aid dispensers fit and sell hearing aids, take ear mold impressions, post fitting procedures, and directly observe the ear and test hearing in connection with the fitting and selling hearing aids. Audiologists identify hearing, auditory system, and balance disorders, and provide rehabilitative services, including hearing aids and other assistive listening devices.

Both hearing aid dispensers and audiologists are required to provide consumers with written receipts that contain important information about the licensee and the device, including warranty details and details about how to follow up for service and fit adjustments.

1. Related Legislation This Year. AB 161 (Ting), beginning January 1, 2022, prohibits stores from providing paper receipts to consumers except upon request. (Status: The measure is pending in the Assembly Committee on Privacy and Consumer Protection.)

SUPPORT AND OPPOSITION:

Support:

None on file as of March 26, 2019.

Opposition:

None on file as of March 26, 2019.

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